Thyroid Disorders Can Raise Risk for Osteoporosis and Spinal Fracture

If you have a thyroid disorder, such as hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid), it’s important to understand that you may be at increased risk for developing osteoporosis. Osteoporosis is a condition where your bones are weakened, which can lead to painful and debilitating spinal fractures, so understanding the association between thyroid hormone imbalance and bone density loss can help you take preventive steps to keep your bones healthy.

thyroid glandThyroid disorders, like hyperthyroidism or hypothyroidism, are secondary causes of osteoporosis. Photo Source:

Osteoporosis Basics: What You Need to Know

Osteoporosis means “porous bone,” and it’s a condition characterized by low bone mineral density (BMD) and structural bone weakness. Osteoporosis has several risk factors—some you can control, others you can’t. The disease can affect men and women. Being over age 50 and female are common uncontrollable risk factors; diet, smoking status, and physical activity are controllable lifestyle factors that may affect the likelihood of developing bone loss.

Osteoporosis is caused when the 2 types of bone cells—osteoclasts and osteoblasts— don’t work in harmony. The bones of your skeleton are alive, not static and ever-changing. Osteoclasts break down old bone while osteoblasts create new replacement bone—this process is called bone remodeling.

Your bones lose density when osteoclasts work faster than osteoblasts can keep up, leading to the development of osteoporosis. Your diet, physical activity level, and hormones can all affect your body’s ability to keep these 2 types of bone remodeling cells in healthy balance.

bone remodeling process; how new bone replaces old boneThe bone remodeling process involves breaking down old bone and replacing it with new bone. Photo Source:

Linking Thyroid Disorders and Bone Loss

Thyroid disorders are considered secondary causes of osteoporosis. That means thyroid disorders do not directly cause osteoporosis or spinal fractures, but abnormal levels of thyroid hormone may influence your body’s metabolism—its ability to maintain healthy bone density through the remodeling process.

  • Hyperthyroidism is the thyroid disorder that has the strongest association to osteoporosis.

The thyroid releases 2 hormones: thyroxine (T4) and triiodothyronine (T3). If you have hyperthyroidism—that is, your body produces too much T4—you have an increased risk of developing osteoporosis because being hyperthyroid can trigger an imbalance of bone-eroding activity by the osteoclasts.

  • An excess of T4 speeds up the work of osteoclasts, making it difficult for the bone-building osteoblasts to keep up. If the osteoclasts work faster than the osteoblasts, your bones lose density (strength), become fragile and/or brittle raising the risk for fracture.

It’s important to understand that having hyperthyroidism does not mean you’ll definitely develop bone loss or osteoporosis. The bone-remodeling imbalance occurs if your hyperthyroidism is left untreated. The good news is that proper management of T4 levels can help prevent osteoporosis and bone loss. If you’ve experienced bone loss as a result of your hyperthyroidism, treatments may both balance your T4 hormone and help rebuild your bone density.

Having sustained high levels of T4 from untreated hyperthyroidism is strongly associated with bone loss and increased fracture risk, but it’s not the only thyroid disorder with a connection to osteoporosis. Although more evidence is needed to support the connection, people who have abnormally low thyroid-stimulating hormone (TSH) levels with normal free thyroxine (FT4) could also have a heightened risk of bone loss and spinal fracture.1

Hypothyroidism, or underactive thyroid, has less of a direct tie to osteoporosis than hyperthyroidism. However, it’s important you maintain hormone testing (eg, blood tests) at least yearly to ensure your treatment keeps your thyroid hormones within a healthy range. If your hypothyroidism treatment raises your thyroid levels too high for a sustained period, you may develop bone loss and osteoporosis. That is one reason why periodic blood tests to measure thyroid function are so important—thyroid hormone levels can be affected by different changes, such as diet and body weight.

Osteoporotic Vertebral Fracture: Cause and Effect

When your bones lose density and strength, they can fracture, or break. Osteoporosis affecting the spine’s bones may cause a vertebral body to collapse, leading to a type of osteoporotic fracture called a vertebral compression fracture (VCF).

You may think you need to endure a serious traumatic event like a car accident or fall to experience a spinal vertebral fracture, but that’s not always the case. Osteoporosis can weaken spinal bones to the point that even everyday movements and activities, such as bending over or carrying a large load, can cause a VCF.

Spinal fractures are painful and can reduce your quality of life in many ways. VCFs can limit your mobility; everyday activities like walking, bathing and dressing can become challenging and difficult. Also, one spinal fracture may increase the likelihood you’ll fracture another bone in your body (such as a hip).

Talk to Your Doctor About Osteoporosis Prevention

Now that you understand the link between thyroid disease and osteoporosis, the next step is to talk to your doctor. Considering your personal medical history, your doctor can recommend whether you should undergo thyroid function and/or bone mineral density testing. Your doctor will share ways you can proactively protect your spinal bone health.

Osteoporosis is often a preventable and controllable disease, and you and your doctor can discuss the many ways you can preserve your bone health for years to come. Eating nutrient-dense foods, staying active and kicking a smoking habit are just a few bone-boosting strategies. Explore more ways to prevent osteoporosis and spinal fractures in How to Start Your Osteoporosis Prevention Plan Today.

Updated on: 03/09/20
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